What does the cost include?

Our quoted fee on the website is the “out-the-door” price. This means that it includes everything that we recommend doing that day. There are no hidden fees. It includes pre-operative bloodwork, pre-op and post-op x-rays, IV catheter, anesthesia, surgery, go-home medications, and buster collar. The only things not included are any recheck visit fees or if you ask us to do something extra that day, like place a microchip or give a vaccine.
Make sure that if you are getting quotes for a TPLO from another office, that you ask for the total cost and not just the surgical fee, as most places unbundle the TPLO price into 10-15 parts that are each required but not mentioned over the phone. We feel that this process is deceptive and it goes against our clinic philosophy.

Can I get a discount for ……?

Unfortunately not. Our price is already heavily discounted and was chosen very carefully - knowing that some clients and pets will need more care or time than others. We chose one clear, simple price that we thought would be fair for pets of all sizes and needs.
One of the most common discount requests comes from clients who have already paid for blood-work at another clinic. This argument is a compelling one but even if your previous results were from 1-2 weeks prior, we still prefer to run our own bloodwork the day of surgery. This is because the value of older results diminishes each week, and laboratory errors are common in machines that are not properly calibrated or maintained. Also, we don’t charge anything for the pre-surgical bloodwork done at our office - we do it for peace-of-mind that your pet is a good candidate for surgery.
Another common discount request is for pets who already have had x-rays taken elsewhere. We still take our own x-rays - at no-charge - the day of the surgery for a few reasons: 1) We need to make specific measurements that are as precise as a millimeter, and this requires the leg to be relaxed and in a very specific position that our x-ray technicians are great at and 2) Changes can happen in x-rays over the course of just a few weeks in a knee with a torn ligament. We’d like to see those changes and plan accordingly.

What could go wrong?

The most common thing we worry about is infection. We always send you home with antibiotics, but it doesn’t completely take away the risk of infection. Infections usually happen if a pet is able to lick at their incision. That’s why it’s very important to keep the cone on them until the stitches or staples are ready to be taken out - after 14 to 21 days. If a rash develops on the skin or you think your pet has been licking or scratching at their surgery site - let us know. We may need to prescribe a course of antibiotics. The risk of a superficial infection needing a round of medicine is about 10%. The risk that the TPLO implant will get infected and need to be removed at some point in the future is 2 to 3%.
Just like any surgery requiring general anesthesia, there are anesthetic risks. However, the risk of serious injury or death from routine anesthesia in a healthy patient is exceedingly low - on the order of 1 in 1,500 surgeries. This is the same as with human surgery. We take every reasonable precaution to prevent this and have been happy with our results.

Why do some animals heal at different rates?

Younger animals (1-4 years old) usually heal in 6-8 weeks. Older animals (8-10 years old) usually take 12-16 weeks to heal. Overweight animals heal more slowly, and also pets that are rambunctious or hard to confine. If your pet is hard to confine or may have separation anxiety issues when you leave the house, mention that to the veterinarian the day of the surgery and they may recommend a short course of sedatives for a few weeks.

Why is our cost so low?

We’ve decided that we can help a greater number of animals and also achieve greater professional success if we do more TPLOs at a lower cost, rather than fewer TPLOs at a higher cost. Our surgical methods and materials used are the same high quality as any other reputable provider of this surgery. Our TPLO implant and screws are swiss-manufactured titanium.

We’ve done so many over the last few years that we also get faster at the whole process, and can fit more procedures into each day.
I think the more apt question is “Why is the Bay Area cost for TPLO so high?”. I believe that there is a supply/demand imbalance here. 1) Many pets need this surgery, 2) Owners are more willing to cover the cost of the TPLO, 3) There are few veterinarians in the area that are trained to perform the TPLO.

What is a meniscal release and do we do that as well?

The meniscus is a cushion that sits in-between the femur and tibia. There are two in each knee. Many times, when a dog tears their cruciate ligament, they also tear their medial meniscus. If we don’t do something about that, the meniscus can continue to cause pain even if the TPLO surgery was otherwise successful. Repairing the meniscal tear doesn’t work well. Therefore, we release the attachment between the meniscus and tibia, so that it doesn’t get in the way of knee movement and it no longer causes any pain. We perform a meniscal release in every TPLO we do. Not every veterinarian does this, and both sides have good points. We choose to release every meniscus because: 1) Many times the meniscus is already torn but not detectable during the surgery and 2) sometimes the meniscus can tear even after a successful TPLO surgery.

Why did my other hospital recommend hospitalization overnight and you do not?

You’ll find slightly different recommendations from any hospital that you consult with on this surgery. We’ve found overnight hospitalization to not be necessary. The night of the surgery, your pet will be awake and walking around on their own. We think that they’ll be more comfortable in the familiar environment of their home, than at the hospital.

What’s the difference between boarded and non-boarded veterinarians?

A board certified surgeon has undergone a multi-year residency program similar to what human surgeons go through. They’ve spent this time focused on expanding their surgical skills and experience. A regular veterinarian, in contrast, typically doesn’t see the same amount and variety of surgery. A board certification gives you immediate assurance that the surgeon in question has specialized expertise that a regular veterinarian typically doesn’t have.
Our doctors have not undergone a residency program or board certification for veterinary surgery. However, they have completed advanced courses in fracture repair and joint repair and we perform about 300 TPLOs a year as well as 100 fracture repairs. Our expertise comes from our experience and reputation as one of the most sought after clinics for fractures and TPLOs.

Both my dog’s legs need surgery. Can you do both at the same time?

We can do both legs at the same time, but we don’t recommend it. This question is controversial amongst veterinarians. Some say it’s better to wait 4-5 months between surgeries, and others say it’s ok to do both legs at the same time. We’ve always done one leg at a time, and we have had wonderful results this way.

Can we do other add-on procedures while my pet is under for their TPLO?

It depends on the procedure. If it’s a simple skin mass removal, then we likely can do that. If it’s a dental cleaning, then we cannot. Dental cleanings cause the release of bacteria into the blood stream which may compromise our surgery. So, if you are interested in adding on an additional procedure, ask about that early in the process to see if it can be done.

Will I be seeing the veterinarian the day of surgery?

Typically not. The day of surgery is a busy one for the veterinarian. Besides your pet’s TPLO, there may be 1-3 other TPLOs that day, in addition to other surgical procedures scheduled. The veterinarian’s morning time is dedicated to exams and drug calculations, the middle of the day is filled with 6 to 8 hours of surgery, and the evening hours are for filling go-home medications and logging medical notes.
We are more than happy to address simple concerns that you relay to our staff, and we will certainly call you or talk to you in person if we find any medical ailments or noteworthy items during your pet’s stay with us. If, however, you have multiple other issues that you’d like addressed that are not directly related to the surgery, we ask that you schedule a separate exam with one of our doctors so that we can devote a proper amount of time to addressing those additional concerns.

Do I need to be seen before scheduling the surgery?

You do not need to be seen prior to surgery if another veterinarian has diagnosed your pet with a torn CCL. We do ask that you contact your regular veterinarian to have them forward their medical records and x-rays to us so that we can look them over prior to the surgery day. The day of the procedure, after we have administered a sedative, we still perform our own focused physical exam and take our own x-rays. If our findings disagree with the diagnosis of a torn CCL, we will hold off on the surgery and contact you immediately.
If you do not have a firm diagnosis of a torn CCL from your regular veterinarian, then we do ask that you schedule a consultation with us prior to scheduling surgery, so that we can confirm that we are doing the right procedure.